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Council research in Pakistan showed that misoprostol can be used safely by women at home to effectively prevent postpartum hemorrhage.

The Issue

Postpartum hemorrhage is the leading cause of maternal mortality in Pakistan. Globally, postpartum hemorrhage is often prevented with oxytocin at the time of delivery; however, oxytocin must be administered via injection and needs to be stored at cool temperatures. This makes it impractical for use in much of Pakistan, where two-thirds of births occur at home without a skilled birth attendant.

Misoprostol is an alternative option for preventing postpartum hemorrhage, available in an inexpensive tablet form that does not require special conditions for storage.

The Progress

In 2010, the Council conducted a quasi-experimental study to provide misoprostol to pregnant women and their expected birth attendants in two rural districts in Pakistan. In both districts, women and their attendants received information and counseling about safe delivery and postpartum hemorrhage as well as a clean delivery kit. In the intervention group only, counseling included information about administration of misoprostol, and misoprostol tablets and informational materials were included in delivery kits.

A total of 1,698 women participated in the study (872 in the intervention group and 826 in the comparison group). In the intervention group, 770 of the women (88%) delivered their babies at home, and 647 (84%) of these used misoprostol tablets in the correct dosage and at the correct time during delivery.

Although 40% of the women who correctly took misoprostol tablets experienced side effects (primarily shivering/chills), these were temporary and did not require specialized care or treatment. Nine in ten (91%) women who used misoprostol said they would use it again, and all but two women said they would recommend the drug to others.

Three women in the intervention group suffered from postpartum hemorrhage that required referral to a health facility. Two of these women had taken misoprostol during delivery; the third woman, who had not taken misoprostol, later died. There were no maternal deaths within the home setting in either the intervention or comparison groups.

The Impact

The Council’s research in Pakistan contributes to a growing body of evidence that trained traditional birth attendants or family members can safely administer misoprostol to women delivering at home. In 2011, the World Health Organization updated its guidelines to recommend misoprostol use to prevent postpartum hemorrhage in settings where it is not possible to provide oxytocin.

Several provinces in Pakistan have added this life-saving intervention to their essential medicines list, and the Council is working with the Ministry of Health to include misoprostol on the national list.